Anteromedial Surgical Approach for Minimally Invasive Fixation of Humerus Shaft Fractures: A Cadaveric and Clinical Study

The authors describe a new anteromedial (AM) approach for minimally invasive fixation of humerus fractures. A cadaveric study was done initially, followed by the clinical study in a single level 1 trauma center. The AM approach was initially described by cadaveric dissection where the proximal and distal intervals were delineated. The interval for the proximal incision was between the biceps and pectoralis major muscle and the distal interval was made by splitting the brachialis muscle above the medial epicondyle. Six cadavers (12 limbs) were dissected to describe this approach. The same approach was then used on a series of 5 patients with acute humerus fracture. The outcomes which were measured were intraoperative complications, radiologic evidence of union, and functional scores. The cadaveric dissection indicated that the median nerve, brachial artery, musculocutaneous nerve, and the ulnar nerve were safe during plate application. The radial nerve was not encountered during this approach. In the clinical series, all the patients had united with good functional scores and no infection. There were no intraoperative complications or nerve palsies. The AM minimally invasive approach for the humerus fracture fixation is a safe procedure in patients as demonstrated by our cadaveric study and verified by our clinical results.